Hospice: The Case of Mrs. D

Mrs. D was a 78-year-old Cuban American who was caring for her 80 year old husband in the end stages of probable Alzheimer’s Disease. They had two adult children who live in the same city, however, not in close proximity. Mrs. D spoke limited English and was referred to the social service agency by an Adult Day Health Center located two blocks away. Members of the Center had tried many times to help Mrs. D, however, she repeatedly refused any outside help. She said, “No tengo confianza en personas que no conozco” (I don’t trust people that I don’t know).

Mr. D required total care, and Mrs. D had one friend who came to her house to bathe and transfer him to the wheelchair each morning. The friend returned in the evening to transfer Mr. D back to bed. Mrs. D said that she prayed daily for strength to help her keep going as she worried about her own health. She was very upset as she reminisced about the 30+ years with her husband. She described their relationship as being very close and they functioned as a team. “Compartimos el café de la misma taza” (We share coffee from the same cup).

Talking about his death was difficult and she said that she would prefer to suffer the burden of caring for him the way he was than not having him around at all. She said that living in the U.S, was so different from living in Cuba or any Latin American country. “Here the children live far away and work all day everyone is busy. In Cuba, there would always be someone around to help or just to check in-a niece, cousin, aunt.” Although she could rely on her son, she did not want to impose on him because he had an important job. Mrs. D was very tearful and said that she never expected her husband to get this disease. “Yo rezo mis oraciones a diario, mi fe es en Dios, porque Dios es poderoso” (I say my daily prayers, I have faith in God because he is powerful).

Questions for Discussion

1. What types of interventions could be used in order to provide Mr. and Mrs. D with supportive services?

2. SHow does the case of Mrs. D illustrate the lack of knowledge, language barrier and distrust of “outsiders” as reasons for not utilizing formal home care or Hospice services?

3. How would knowledge of the historical experiences and characteristics of Mrs. D.’s cohort help providers to understand her reluctance to accept services?